Cardiac Catheterization with angioplasty is the procedure that allows the doctor to study the condition of your heart including the muscle ,valves and artery. It can also be used to open the blocked coronary artery and improves blood and oxygen flow in the heart without the surgery. To begin the cardiac catheterization with angioplasty the doctor chooses an artery for the catheter entry site. Most commonly an artery in the groin or arteries in the elbow are used. Once the area is known the Doctor will introduce the introducer, which is a thin plastic tube, in to the artery through this the guide wire is lowered in to the artery the catheter small plastic tube in to the artery.
Through this a guide wire is lowered into the artery and the catheter a small flexible tube is inserted over the wire and carefully advanced to the heart through the aorta and to the coronary artery. Catheter movement is viewed on the x-ray screen. Once the catheter reaches the coronary artery dye is injected into them. This special dye shows up on the x-ray screen and allows the Doctor to see the blockages that may be present. The Doctor will repeat the injection of dye several times looking at the artery from many different angles. After the artery are examined, the catheter will be redirected to left ventricle. This is to test how the ventricle is contracting if the valves are functioning properly.
The CPT code for this procedure will be 93458 as we bill for professional component we will use 26 Modifier.
“93458 – Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed”
If the Doctor injects the dye and locates the blockage he/she will prepares for the balloon angioplasty. During the balloon angioplasty, the Doctor injects the special balloon tipped catheter into the artery and guides it to the blockage.
Once the balloon tipped catheter is placed correctly it inflated and deflated several times. With the successful angioplasty the blockage is squeezed outward against the wall of the artery and blood flow is restored.
The CPT codes for Balloon Angioplasty will be 92920 with modifier LM, LC, LD, RC, RI.
“92920 – Percutaneous transluminal coronary angioplasty; single major coronary artery or branch”
“ 92921- Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure
Depending on the specifics of the blockage the Dr may place a stent in the artery. The stent is expandable device that is mounted on the balloon catheter. The stent and balloon are advanced to the blockage area and the stent expanded in to the place. Stent supports the artery and helps it to remain open for a longer period of time. after stent placement the body will grow tissue to help maintain its position.
The stent will not move around. Procedure will take 1 to 3 hours this varies to patient. Once the procedure is complete the Doctor will take the catheter but the introducer may remain in the artery. the Doctor will leads the introducer in place for a period of time in case of artery re-closure is encountered or happen.
The CPT code for Coronary Angioplasty with Stent placement in single major coronary artery will be 92928 with modifiers LM, LC, LD, RC, RI.
CMS has created two new HCPCS Level II modifiers to represent the left main (-LM) and ramus (-RI). Existing modifiers for left circumflex (-LC), left anterior descending (-LD), and right coronary (-RC) remain the same.
“92928 – Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch”
“92929 – Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)”.